California law allows for a second opinion consultation when you have questions about a diagnosis, want more information about a treatment plan or if you are not satisfied with the results of treatment you have received.
If you’ve seen a specialist in your medical group (e.g. Mercy Medical Center), you may request a second opinion consultation with a physician outside of your medical group from your insurance plan (e.g. Health Net, Kaiser, Anthem Blue Cross). See the requirements by plan listed below.
The consulting physician must be a provider for your insurance plan. The approval will go faster if you know which specialist you wish to consult for the second opinion.
Second opinion referrals are for consultation ONLY. The consulting physician will not be able to order tests or provide any treatment unless that level of care is pre-approved in the referral authorization. You should provide the second opinion specialist with all relevant medical records and test results for review - take them with you or send them to the specialist prior to your appointment. (Make sure you request your records well in advance of the appointment.)
You pay your normal office visit copay.
Call your insurance plan to request a second opinion consultation.
- The member services representative will ask you a few questions to clarify your situation:
- what is your diagnosis
- the name of the specialist you consulted in your medical group
- the name of the physician you wish to see for the second opinion consultation
- The insurance will confirm the consulting physician is in the HMO network.
- Once the consultation is approved, the insurance will send both you and the consulting physician a written authorization explaining the limits of the consultation.
1-800-539-4072 Health Net Member Services
1-800-464-4000 Kaiser Member Services
1-888-209-7975 Anthem Blue Cross Plus Member Services
Requirements by Plan:
Blue Cross Plus – In-Network (HMO):
Blue Cross Plus members must FIRST ask their HMO physician for an authorization to see a physician outside of their HMO medical group for the second opinion. If that request is denied by the physician or the medical group, the member can call Anthem member services to request a second opinion consultation.
Tell Anthem Member Services that you wish to use your in-network benefits for the consultation. Ask Member Services to refer the request to the Transition Department for review. You can select from Anthem Plus and Anthem PPO providers for the second opinion.
Health Net HMO
The second opinion physician MUST be in the SAME specialty as that of the specialist seen within the medical group. You may select from Health Net and Health Net Blue Gold physicians.
